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*-SANTA <br />NAqffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana. cA 92702 <br />(7't4) 647.5800 <br />r&,/!r'r& saata-ana crq <br />Smoke & CO <br />Alarm Affidavit <br />rNsP-02 20r 3 cRC <br />This document may be found dt.h ttp://\,\^/\/y/. sa n ta -a na orqi pba ' <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:I3Z0 L UJOCd St .Sc,ntrr Atr,1 (A cti-tot <br />Permit Number:\0\ q\r 1r5 <br />Property Owner:YAvardt ffe{n <br />1SCA/ T.-J.',.License # <br />State of California requires that smoke and carbon monoxide iCO) alarms are installed in residential <br />buildings. <br />California Resldential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />A eoah boxes below must be checked: <br />[l CarUon monoxide alarms: Are instailed outside of each sleeping area in the immediate vicinity ot <br />bedrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />El Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeprng <br />room, and on each level of the dwelling. <br />Retrofitted detectors may be battery'operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Battery life must be 10 years. <br />I hereby certify that I am the contractor or the property owner of the above project. I further certify <br />that smoke alarms and carbon monoxade alarms have been installed in compliance with the governrng <br />Codes and have been tested to be functional. l, also, hereby certify that lwill retest the alarms per the <br />man ufactu rer's instructions. <br />lcheck one)Lacensed Contractor Property Owner <br />NOTE: Ihrs sef-certificdtion is only used for projects thot dflect the EXTERIoR of the structure. This <br />process is applicable ONLY to projects where access to the interior of the dwelling by a Sonto Ana <br />lnspectot is not required. <br />Signdture:Ddte:1l tqi lB <br />Have this completed form and the job-card readily available on final inspection! <br />Contractor: <br />tr